Objective To clarify the definition of giant paraspinal dumbbell tumor at thoracolumbar junction and establish the clinical classification.The surgical treatment strategy of giant paraspinal dumbbell tumor at thoracolumbar junction was selected according to the preoperative clinical classification.Methods 11 patients with giant paraspinal dumbbell tumors at the thoracolumbar junction admitted to General Hospital of the Southern Theater Command of China from January 2018 to January 2023 were analyzed retrospectively.According to the relationship between the tumor and the relative anatomical position of the thoracolumbar vertebrae,the distance between the transverse farthest end of the tumor and the posterior midline of the spine ≥6 cm was defined as a huge dumbbell tumor at the thoracolumbar junction,and a new clinical classification was established,paraspinal type(tumor not exceeding the anterior edge of vertebral body)and prevertebral type(tumor exceeding anterior edge of vertebral body).Posterior tumor resection was performed for paraspinal type and posterior combined with anterior tumor resection for prevertebral type.X-ray,CT and MRI examinations were performed at 1 week,3 months,6 months,12 months and every year to evaluate tumor resection,recurrence,spinal stability and internal fixation,spinal cord nerve function was evaluated,and postoperative pain improvement was evaluated.Results In 8 cases of paraspinal type,posterior tumor resection with fixation was performed in 5,and simple posterior tumor resection was performed in 3.In 3 cases of prevertebral type,posterior combined with anterior resection was performed in 2,and posterior combined with anterior resection with fixation was performed in 1.There was a statistically significant difference in JOA and VAS scores between preoperative and postoperative(P=0.03,P＜0.001).Postoperative histopathology confirmed neurilemmoma in 9 and neurofibroma in 2.All 11 cases were followed up,and the follow-up period ranged from 6 months to 5 years.No tumor recurrence was found in all patients,the neurological symptoms were significantly improved,there was no pain in the chest,waist and back,and there was no loosening or fracture of the internal fixation.Conclusions The distance between the furthest transverse end of the tumor and the posterior midline of the spine ≥ 6 cm is a huge dumbbell tumor at the thoracolumbar junction,which can be divided into paraspinal type and prevertebral type.Satisfactory resection can be achieved by simple posterior tumor resection in paraspinal type,and satisfactory resection can be achieved by posterior combined with anterior tumor resection in prevertebral type.
giant paraspinal dumbbell tumor at thoracolumbar junctionclinical classificationsurgical treatment strategy
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